Midterm Outcomes of the Minos Ultralow Profile Endograft: Results from the Multicentre MINER Registry.

OBJECTIVE

The aim of this study was to assess midterm outcomes of the ultralow profile Minos endograft in a physician initiated registry.

METHODS

A non-sponsored registry collected consecutive patients treated with the Minos device in 20 Italian centres (2021 - 2025). Elective patients (the primary analysis population) were stratified by access quality (hostile vs. standard access); hostile iliac-femoral access was defined by a narrowest iliac diameter < 7 mm, iliac artery tortuosity index > 1.6, aortic bifurcation diameter < 16 mm, or severe circumferential calcification. Proximal neck features were covariates only; urgent and emergent procedures were analysed separately. Outcomes were thirty day technical success, mortality, and major adverse events (MAEs), and midterm freedom from rupture, limb occlusion, type I or III endoleak, and re-intervention.

RESULTS

Of 310 patients (mean aneurysm diameter 54.8 ± 10.0 mm), 288 (92.9%) were elective. Among these, 154 (53.5%) had a standard access and 134 (46.5%) a hostile access. The latter were more frequently women (16.4% vs. 6.0%; p = .009) and more frequently had peripheral arterial disease (31.6% vs. 16.8%; p = .006). Elective technical success was 100%, with no thirty day deaths. The thirty day MAE rate was higher with hostile access (8.2% vs. 1.3%; p = .032), mainly from access related events and blood loss > 1 000 mL (3.7% vs. 0.0%; p = .021), as was early re-intervention (3.7% vs. 0.0%; p = .021). At 3 years there were no aneurysm related deaths; freedom from limb occlusion was 97% vs. 100% (p = .025) and from type I OR III endoleak was 98% vs. 100% (p = .18) in the standard and hostile access groups, respectively.

CONCLUSION

The Minos ultralow profile endograft was safe and effective for the treatment of elective abdominal aortic aneurysms. Peri-operative morbidity was higher when the iliac-femoral access was hostile, and limb occlusion, type I - III endoleak, and re-intervention were more evident compared with standard access anatomy. An ultralow profile platform can extend endovascular repair to unfavourable access vessels without affecting midterm device performance.